Innovation still continues to be an illusive dream for many executives in the healthcare industry. Two main reasons? Large health systems are too afraid to fail and executives believe they can only innovate with their current resources.
Their worries are not completely far-fetched.
Incorporating new and disruptive technologies comes with significant challenges. Before implementing new devices, applications, or databases, CEOs must first ponder how workflows and patients will be affected by change.
There are even more challenges when leaders in healthcare decide to invest in a foreign health tech startup. This is where Integrated Delivery Networks (IDNs) come into play.
IDNs either own or manage multiple points of patient care – from hospitals to physician practices to long term care facilities. Their goal is to manage cost and quality of care; and they do so by integrating new technologies as smoothly as possible.
As Vice President and Chief Medical Information Officer at Northwell Health, Dr. Michael Oppenheim’s knows exactly how to do that.
The Chicago-Israel Health Tech Summit provided him the platform to share his best advice with 20 of Israel’s most promising health tech startups with plans to penetrate into the U.S. market.
Innovation without a roadmap – a recipe for disaster
His talk was designed to show these startups – and their investors – what it takes to implement their ideas with the help of a large IDN.
Oppenheim started his keynote speech with a blunt statement: “What you perceive as resistance is not resistance to your product or invention. You might have a killer solution, but unless you figure out the whole continuum of care workflow, it’s going to be challenging.”
A lot of things can go wrong without a comprehensive implementation roadmap, Oppenheim said. Even something as simple as an ADT interface, a tool which enables the exchange of a patient’s state within a healthcare facility, can have a massive ripple effect on an institution’s workflow.
“How hard can that be?” Oppenheim asked.
He answered that by showing the audience an intricate diagram of a hospital in the process of integrating an ADT. This was a small, 70-bed hospital, transitioning from a Legacy EMR platform to an Allscripts platform. Even so, Oppenheim and his colleagues prepared no less 23 IDN patient scenarios to test.
No matter how small a project might be, it still requires a huge mobilization to get it up and running.
“We are bringing people from a procurement department, from a legal department, we have a security group, one that focuses on infrastructure and even a testing center of excellence,” Oppenheim explained.
Electronic medical records make or break a novel technology
Oppenheim went on to talk about the realities of Electronic Medical Records (EMR) data.
Oppenheim said IDNs like the one he represents are skeptical of plugging in a new solution without taking EMRs into account. There’s no such thing as simply taking the data, plugging it into a new software and reusing it.
Patients might not return to a hospital or clinic until years later. Meanwhile, no one has updated their or deactivated their data. When those patients do come back to a hospital that has since adopted a new artificial intelligence engine, for instance, physicians are going to have a distorted picture of their health.
“You’re going to start seeing things that don’t exist,” Oppenheim said. “We’re very good at putting in what’s right, we’re bad at kicking out what’s no longer relevant.”
Clinical data, he said, is created through a process dictated by insurers, not by physicians.
Oppenheim, who specializes in infectious diseases, gave the example of one of his patients. The man had a collection of pus around his heart. Northwell Health surgeons successfully operated on him and while his health greatly improved, the data didn’t reflect that. In order to get paid by insurers, Northwell physicians had to send specific billing claims for the health conditions the patient was treated for.
“He looks fenomenal now, but if you put any AI on this patient he looks like the sickest guy you’ll ever meet.” Oppenheim told the audience of Israeli startups founders that “unless you roll up your sleeves and get to know our data, you systems will fall apart.”
Intake forms are also not the most reliable tools, as physicians records don’t necessarily match those of nurses.
A simple example: documenting the tobacco usage of a patient. The doctor might be talking to the daughter who’s in the emergency room with a patient and asking ‘Does your dad smoke?’ to which she might say ‘Yes, he smokes a lot.”
Later, when the patient would settle in his hospital bed and his family members would go home, he might tell the nurse he doesn’t smoke at all.
Another thing to consider when implementing a new technology?
How much it will interfere with clinicians’ workflow. Medical staffers are already working with a plethora of systems on a regular basis, so startups must make it easier for them to use their product. “That is critical for your success,” Oppenheim said.
Many startups believe in the fail-fast philosophy, where they will test an idea and quickly try something else if it’s not working.
Oppenheim argued this approach is like stacking the deck against success. Instead, he suggested implementing in a way that feels natural to a clinician: “It
will only work if they are sufficiently motivated to stop whatever they’re doing elsewhere and do this thing you’re asking them to do.”
Keeping hackers away
Regulatory mandates and cyber security policies could also pose an obstacle for new companies trying to penetrate the U.S. healthcare market.
Oppenheim presented the crowd with some dauting facts: cyber hackers are getting $50 for a patient’s medical record and $1 for their Social Security Number.
It all adds up to millions of dollars. In the second quarter of 2018 alone, over three million patient records were exposed in 142 healthcare data breaches.
“Think about this when you’re walking in with your cloud-based app,” said Oppenheim, whose IDNs has new clients fill out more than 40 pages of security questions.
Oppenheim ended his presentation with a couple of final tips for entrepreneurs:
- Think end-to-end. How your solution will work with everything that happened before and after.
- Be realistic about project management timelines.
- Think how you can capture a clinician’s attention.
The Northwell Health expert wasn’t the only one to stir up conversations during the three-day summit. In addition to one-on-one meetings between Israeli health tech entrepreneurs and Chicago executives, the event featured presentations by leaders from Amita, Northwestern Medicine, OSF HealthCare, and UI Health.